Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women as of January 2015

Feb 02, 2015

This fact sheet provides an overview of eligibility levels for parents, other non-disabled adults, children, and pregnant women in Medicaid and CHIP as of January 2015, one year after key Medicaid provisions in the Affordable Care Act (ACA) took effect. The findings highlight Medicaid’s expanded role for low-income adults under the ACA and its continued role as a primary source of coverage for children and pregnant women. State-specific data is available in Tables 1-3.

As of January 2015, 29 states set their Medicaid income eligibility levels for parents and other adults to at least 138% FPL, reflecting their adoption of the ACA Medicaid expansion (Figures 1 and 2, Table 1-1A). As enacted, the ACA expanded Medicaid eligibility to adults with incomes at or below 138% of the federal poverty level (FPL) ($27,310 for a family of three in 2014), although this provision was effectively made a state option by the Supreme Court’s 2012 ruling on the constitutionality of the ACA. As of January 2015, eligibility levels for parents and other adults are at or above 138% FPL in the 29 states that have adopted the Medicaid expansion. Two expansion states extend Medicaid income eligibility limits for parents and/or other adults above the ACA minimum levels (DC at 221% FPL and CT at 201% FPL).

Figure 1: Medicaid Income Eligibility Levels for Parents of Dependent Children, January 2015

In the 22 states that have not adopted the Medicaid expansion, the median income eligibility limit for parents is 46% FPL, and, with only one exception, childless adults are ineligible for Medicaid (Figure 3). As of January 2015, 13 states limit parent eligibility to less than half of the poverty level, and only four of the non-expansion states (AK, ME, TN, and WI) extend eligibility to parents at or above poverty. Wisconsin is the only non-expansion state that provides full Medicaid to any childless adults, although eligibility at 100% FPL remains below the expansion level.1 In the other non-expansion states, parents and other adults with incomes above Medicaid eligibility limits but below 100% FPL fall into a coverage gap; they are ineligible for Medicaid but do not earn enough to qualify for the premium tax credits for Marketplace coverage, which are not available to those with incomes below 100% FPL. Nearly four million uninsured adults are in this coverage gap.2

Figure 3: Medicaid Income Eligibility Limits for Adults in States Not Adopting the Medicaid Expansion at this Time, January 2015

Medicaid and CHIP coverage for children and pregnant women remains considerably higher than adult coverage across all states. As of January 2015, 28 states cover children with family incomes at or above 250% FPL, with 19 extending coverage to 300% FPL or higher (Figure 4, Table 2-2A). Only two states (ID and ND) limit children’s eligibility to below 200% FPL. Underlying these upper limits, eligibility levels reflect the ACA’s new minimum Medicaid eligibility level of 138% FPL for children of all ages, which resulted in the shift of older children (ages 6 up to 19) with incomes between 100% and 138% FPL from CHIP to Medicaid in some states as of January 2014. With the exception of Arizona, CHIP enrollment is open in all states. The ACA established protections that prohibit states from applying any restrictions in eligibility or enrollment for children through September 2019. Most states extend coverage to pregnant women beyond federal minimums through Medicaid and CHIP. Prior to the ACA, states were required to cover pregnant women in Medicaid to at least 133% FPL. As of January 2015, nearly two-thirds of states (33) cover pregnant women at or above 200% FPL, including ten states that cover pregnant women with family incomes at or above 250% FPL in Medicaid and CHIP (Figure 5, Table 3-3A).

Figure 4: Income Eligibility Levels for Children in Medicaid/CHIP, January 2015

Figure 5: Income Eligibility Levels for Pregnant Women in Medicaid/CHIP, January 2015

In sum, one year after the launch of major Medicaid provisions of the ACA, as expected Medicaid’s role has increased for low-income adults in the 29 states that have adopted the Medicaid expansion. However, eligibility levels for adults remain low in states that have not adopted at this time, resulting in gaps in coverage. There is no deadline by which states must adopt the Medicaid expansion to low-income adults although the full federal financing phases down and debate continues in several states. The ACA protects eligibility levels in Medicaid and CHIP through 2019 but funding for CHIP will not extend beyond September 2015 without congressional action. As a result, state decisions to take up the Medicaid expansion will determine the future scope of coverage for adults while congressional action on CHIP will shape children’s coverage over the next years.

Endnotes

Oklahoma and Utah provide more limited coverage to some childless adults under Section 1115 waiver authority.